Screening for red flags and modifying manual therapy techniques for pediatric patients

Objective: This mini-review synthesizes evidence for safe and effective pediatric joint mobilization, discussing red flags, offering clinical recommendations, and addressing current research limitations. Methods: A PubMed and PEDro search, supplemented by foundational pediatric musculoskeletal resources, identified peer-reviewed articles and guidelines, which experts collaboratively evaluated. Results: Pediatric musculoskeletal systems, with open growth plates and lower bone mineral density, are vulnerable to shear forces. Safe force thresholds remain undefined. Therefore, thorough history taking, systematic red flag screening, and adherence to International Federation of Manual and Musculoskeletal Physical Therapists guidelines are crucial. Discussion: The refined Pediatric Utilization of Manual Therapy tool (PUMT-2, combined with the proposed modified three-tier red flag framework, supports individualized, developmentally appropriate assessment and care. Future research should establish force guidelines and age-based technique modifications, alongside specialized clinician training to address pediatric-specific needs.